How to Navigate a Chemo Drug Shortage

Shortages of medicines have become common in the United States, affecting everything from children’s antibiotics to surgery sedatives. You may have even seen scary headlines in 2023 about the record-high shortage of essential chemotherapy medicines. This included carboplatin and cisplatin — two common, injectable chemotherapy drugs used to treat breast cancer and other cancers. Some cancer treatment centers weren’t able to secure enough of the drugs to guarantee sufficient dosing for all the people with breast cancer who needed them. And in some cases, doctors had to modify treatment plans for their patients.   

The U.S. supply of carboplatin and cisplatin is now thought to be “back to normal,” but what is normal?

“Drug shortages have been with us for so long now that this is the new normal, and many cancer centers have good strategies in place to minimize any disruption to patient care,” says Erin Fox, PharmD, associate chief pharmacy officer at University of Utah Health in Salt Lake City and a national expert on drug shortages.

While there is no data on the exact number of breast cancer patients whose treatment was impacted by the 2023 shortages, survey data suggest that as many as 1 in 10 cancer patients in active treatment may have been affected. 

Understanding why drug shortages happen and how they might impact your care and recovery from breast cancer will allow you to best work with your doctor.

Supply chain issues, COVID, and the financial challenges of making low-cost generic drugs have all contributed to uneven supply. In the case of cisplatin and carboplatin, this was made worse by the closing of the main plant that produced these generic drugs, in India, in late 2022 after quality issues surfaced. (Canada and Europe didn’t experience shortages of these drugs since they rely on multiple other suppliers.)

The profit margin on these two drugs is low, making it hard for producers in countries like the U.S. to pick up the slack. As the New York Times reported, the drugs are inexpensive ($15 per vial for cisplatin, $35 per vial for carboplatin) but require special ingredients and worker safety protections to produce.   

Around the country, some cancer treatment facilities struggled with the shortage much more than others. Even when a cancer treatment facility couldn’t maintain its usual supply of carboplatin and cisplatin, the shortage didn’t always directly affect patient care. The National Comprehensive Cancer Network (NCCN), a group of 33 cancer centers, conducted surveys of its centers to gauge the shortage. In a September 2023 survey, almost all of the NCCN cancer centers that responded said that at that time they were able to maintain treatment regimens for people receiving carboplatin (95%) and cisplatin (88%).

For Kari Wisinski, MD, a breast cancer medical oncologist at the UW Carbone Cancer Center in Madison, Wisconsin, the issue was resolved by the middle of the summer of 2023. Earlier in the year — from March through June — the carboplatin shortage had forced her to change the treatment plans of some of her patients. 

“In my 15 years of practice, we’ve had shortages of several drugs we use for breast cancer care. But the recent shortage of carboplatin was the most serious,” she says.

The changes that oncologists made to some patients’ treatment plans could include:

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  briefly delaying the start of chemotherapy treatment

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  switching to a different chemotherapy drug

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  switching the order in which they would receive chemotherapy drugs

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  lowering the dose of carboplatin or cisplatin

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  extending the time between treatments (for example, giving cisplatin every 4 weeks instead of every 3 weeks)

It’s important to know that oncologists make decisions about modifying treatment plans very carefully and based on clinical guidelines. When a decision is made to extend the time between treatments, for instance, it will usually still fall within acceptable ranges tested in previous clinical trials. 

The American Society of Clinical Oncology (ASCO) published guidelines to help oncologists make decisions about changing breast cancer treatment plans when there is limited availability of carboplatin or cisplatin.

Many health care professionals and patient advocates say that the only way to prevent drug shortages over the long term is through new government policies and legislation. Currently there are several bills Congress is considering passing that could help strengthen the supply chain for generic drugs.  

“This is likely to continue to be a problem until we have some widespread policy changes,” says Dr. Wisinski.

If you’re receiving treatment for breast cancer and hear that there is a chemo shortage, try not to panic or assume that your treatment plan will be affected. 

These are some questions to ask your doctors:

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  Are any of the medicines in my chemotherapy regimen affected by the shortage, or do you expect that they will be?

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  If so, what measures are we taking to prepare for this, and what would the adjusted or alternative regimen be?

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  If you're recommending an alternative treatment plan, what can I expect in terms of different side effects or outcomes?

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  Will I go back to receiving my previous treatment once it becomes available again?

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  Can you help connect me with support services, such as mental health counselors or support groups, to help me cope with anxiety about the drug shortage?

If your cancer center is rationing chemotherapy drugs, the organization Angels for Change, which helps fight drug shortages through advocacy and awareness, may be able to help you find supplies of medicines you need.